Ann Rehabil Med.  2013 Dec;37(6):824-831. 10.5535/arm.2013.37.6.824.

Efficacy of Epidural Neuroplasty Versus Transforaminal Epidural Steroid Injection for the Radiating Pain Caused by a Herniated Lumbar Disc

• Kim HJ
• Rim BC
• Lim JW
• Park NK
• Kang TW
• Sohn MK
• Beom J
• Kang S

• KMID: 2266561
• DOI: http://doi.org/10.5535/arm.2013.37.6.824

Abstract

OBJECTIVE
To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc.
METHODS
Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment.
RESULTS
In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00+/-1.52, 4.29+/-1.20, 2.64+/-0.93, 1.43+/-0.51 and those of FRI were 23.57+/-3.84, 16.50+/-3.48, 11.43+/-2.44, 7.00+/-2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22+/-2.05, 4.28+/-1.67, 2.56+/-1.04, 1.33+/-0.49 and those of FRI were 22.00+/-6.64, 16.22+/-5.07, 11.56+/-4.18, 8.06+/-1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (p<0.05) after the treatment. But there were no significant differences between the two groups statistically.
CONCLUSION
Epidural NP and TFESI are equally effective treatments for the reduction of radiating pain and for improvement of function in patients with a herniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.

Keyword

Epidural neuroplasty; Transforaminal epidural steroid injection; Radiating pain; Herniated lumbar disc

MeSH Terms

Follow-Up Studies
Humans
Magnetic Resonance Imaging
Spine

Figure

• 

  Fig. 1 Epidural neuroplasty fluoroscopic anterioposterior view. (A) Left L5 nerve root filling defect in the epidurogram. (B) Spread of contrast medium at the left L5 nerve root after adhesiolysis.

• 

  Fig. 2 Transforaminal epidural steroid injection (TFESI) (A) Fluoroscopic oblique view after administering the right L5 TFESI with contrast medium, showing the right L5 nerve root. (B) Fluoroscopic anterioposterior view after administering the left S1 TFESI with contrast medium, showing the S1 nerve root.

• 

  Fig. 3 The changes of the visual analogue scale (VAS) over the 8-week follow-up. Epidural NP: epidural neuroplasty, TFESI: transforaminal epidural steroid injection. *p<0.05 comparison between before the treatment and post-treatment by Wilcoxon signed rank test in both the epidural NP and TEFSI groups.

• 

  Fig. 4 The changes of the functional rate index (FRI) for the 8-week follow-up period. Epidural NP: epidural neuroplasty, TFESI: transforaminal epidural steroid injection. *p<0.05 comparison between before the treatment and post-treatment by Wilcoxon signed rank test in both the epidural NP and TEFSI groups.

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